Provider Demographics
NPI:1952679342
Name:WEARNE, EVAN BRYCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:BRYCE
Last Name:WEARNE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 HEATHER HOLLOW CIR APT 21
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2351
Mailing Address - Country:US
Mailing Address - Phone:308-641-0879
Mailing Address - Fax:301-431-6356
Practice Address - Street 1:1511 HEATHER HOLLOW CIR APT 21
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2351
Practice Address - Country:US
Practice Address - Phone:308-641-0879
Practice Address - Fax:301-431-6356
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist